Barriers to Hepatitis C Antiviral Therapy in HIV/HCV Co-Infected Patients in the United States: A Review

Abstract

This review synthesized the literature for barriers to HCV antiviral treatment in persons with HIV/HCV co-infection. Searches of PubMed, Embase, CINAHL, and Web of Science were conducted to identify relevant articles. Articles were excluded based on the following criteria: study conducted outside of the United States, not original research, pediatric study population, experimental study design, non-HIV or non-HCV study population, and article published in a language other than English. Sixteen studies met criteria and varied widely in terms of study setting and design. Hepatic decompensation was the most commonly documented absolute/nonmodifiable medical barrier. Substance use was widely reported as a relative/modifiable medical barrier. Patient-level barriers included nonadherence to medical care, refusal of therapy, and social circumstances. Provider-level barriers included provider inexperience with antiviral treatment and/or reluctance of providers to refer patients for treatment. There are many ongoing challenges that are unique to managing this patient population effectively. Documenting and evaluating these obstacles are critical steps to managing and caring for these individuals in the future. In order to improve uptake of HCV therapy in persons with HIV/HCV co-infection, it is essential that barriers, both new and ongoing, are addressed, otherwise, treatment is of little benefit.

High hepatic and extrahepatic mortality and low treatment uptake in HCV-coinfected persons in the Swiss HIV cohort study between 2001 and 2013

“…Predictors for treatment uptake, including genotype 3, MSM, younger age, no psychiatric disorders and controlled HIV-infection, indicate that therapy was started in the easier-to-treat patients. This is consistent with data from other studies [7,16,18]. Treatment uptake over time did not change significantly in our cohort.…”

“…Although successful treatment of chronic HCV-infection decreased liver-specific and all-cause mortality [5,6], rates of treatment uptake in the HIV-coinfected population were low [7]. Barriers to start treatment included comorbid medical and psychiatric conditions, active substance abuse with the inability to adhere to complex HCV treatment regimens, expected adverse effects of or contraindications for HCV combination therapy, and uncontrolled HIV disease (reviewed in [7]).…”

“…Barriers to start treatment included comorbid medical and psychiatric conditions, active substance abuse with the inability to adhere to complex HCV treatment regimens, expected adverse effects of or contraindications for HCV combination therapy, and uncontrolled HIV disease (reviewed in [7]). …”

Retrospective study of hepatitis C outcomes and treatment in HIV co-infected persons from the Australian HIV Observational Database

“…14,18,19 Treatment uptake in Australian co-infected patients was also substantially higher than the 15% or less in the majority of US studies. 10 This may reflect improving treatment options for HCV over time, with our data being more recent than these other studies. Additionally, in Australia, engagement in HIV care for people living with HIV is generally high.…”

Burden of hepatitis C virus disease and access to hepatitis C virus services in people who inject drugs in India: a cross-sectional study

“…While barriers to HCV care have been well-characterized in affluent settings, 14 it remains unknown if these will directly translate to resource-limited settings. 15 Epidemiologic studies to understand disease burden and HCV service uptake are needed if global control of HCV infection is to become a reality.…”